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Tibet - Health and safety

Health

With Dr Felicity Nicholson

Some important facts to know before you go: Tibetan and Chinese hygiene standards are very poor, and Chinese medical facilities within Tibet are extremely limited. Some conclusions to draw: you may have to be your own doctor in Tibet, you have to be willing to help fellow travellers in dire situations, and you have to be prepared to evacuate if the need arises.

Prior to departure, go and visit your local health unit or travel clinic and get an armful of relevant shots. You would be wise to be up to date with tetanus, polio and diphtheria (all ten-yearly), typhoid and hepatitis A (Havrix Monodose or Avaxim). You would also be wise to consider rabies vaccine for even short trips as there is a shortage of treatment if you have not had pre-exposure vaccine before an incident. For longer trips (four weeks or longer) consider hepatitis B. Both rabies and hepatitis B involve three doses of vaccine, which can take up to two months to give depending on the age of the traveller.

Travellers going to western Tibet should consider vaccinating against tickborne encephalitis. Two doses of vaccine are ideally given at least a month apart but can be given at a two-week interval if time is short. The third dose is given 5–12 months later if you are at continued risk. Talk to your doctor and arm yourself with drugs – Azithromycin or Ciprofloxacin (antibiotics for diarrhoea or respiratory problems), Tinidazole (for giardia or amoebic dysentery) and Diamox (to prevent altitude sickness). Assemble a good medical kit. Check out where your embassies lie in China and in the neighbouring region – note down the addresses and contact numbers. Bring a health certificate to China (it may be checked). Find out your blood group and record it on that document.

Altitude sickness

When Sherpas say climbing is in their blood, they may mean it literally. Sherpas have a physiology adapted to the high-altitude environment –their blood has a higher red-cell count and their lung capacity is larger. Ability to adapt to altitude is thought to be in your genes. That may mean you either have the high-altitude genes or you don’t. If you do, you can adapt quickly; if you don’t, it will take longer – or so the theory goes. At higher altitudes, air pressure is lower and the air is thinner. Although it contains the same percentage of oxygen as it does at sea level, there’s less oxygen delivered in each lungful of air. So you have to breathe harder, and your body adapts over time by increasing the number of red blood cells enabling more oxygen to be carried through the system.

Altitude sickness is something of a mystery. It does not appear to depend on being in shape: athletes have come down with it, and it may occur suddenly in subjects who have not experienced it before. Altitude sickness can occur at elevations above 2,000m, and about 50% of people will experience some symptoms at 3,500m. The higher you go the more pronounced the symptoms could become. So adjustment is required at each 400m of elevation gain after that.

Terrain above 5,000m (common enough in Tibet) is a harsh, alien environment – above 6,000m is a zone where humans were never meant to go. Like diving at depth, going to high altitudes requires special adjustments. To adapt, you have to be in tune with your body. You need to travel with someone who can monitor your condition – and back you up (get you out) if something should go wrong. Consider this: if you were to be transported in a hot-air balloon and dropped on the summit of Everest, without oxygen you would collapse within 10 minutes, and die within an hour. However, a handful of climbers have summitted Everest without oxygen: by attaining a degree of acclimatisation, they have been able to achieve this. A similar analogy could be drawn with flying in from Chengdu, which is barely above sea level, to Lhasa, at 3,650m. That’s a 3,500m gain in an hour or so. You need to rest and recover.

Travel clinics and health information

A full list of current travel clinic websites worldwide is available on ISTM. For other journey preparation information, consult NaTHNac (UK) or CDC (US). Information about various medications may be found on NetDoctor. All advice found online should be used in conjunction with expert advice received prior to or during travel.

Safety

As with any Third World travel situation, you need to keep your wits about you in Tibet. Theft of luggage is uncommon on the plateau, but it does happen. Ditto with rented bicycles – lock yours in a secure, highly visible location. Luggage has even gone missing from some budget hotel storage rooms in Lhasa; to reduce the risk of this happening, identify your baggage with your passport number prominently displayed on an attached label. Keep an eye on your bags when on the move. Pilfering of personal items is known to be a risk when trekking in some areas, particularly the Everest region.

Because of the heavy Chinese military presence in Tibet, armed robbery or similar crimes are extremely rare, though in old Tibet banditry certainly existed in more remote areas. A greater threat to life and limb is on 4x4 sorties and through resulting confrontations that may develop on these trips. Apart from the major health hazard it presents, high altitude is known to befuddle the brain, making you irritable and unable to focus when making decisions or when judgement is required. And there are important decisions that need to be made: for example, to size up quickly those on whom your life depends. That means that, if a rental vehicle or taxi driver refuses to slow down and keeps overtaking recklessly, you may have to bail out.

Confrontations between drivers, guides and passengers over changes of itinerary or other problems can turn ugly. Incidents have involved both Tibetan and Chinese driving crews. In the Everest region, when a driver and his guide (both Tibetan) refused to drive beyond Rongbuk Gompa for the extra dozen kilometres to Everest base camp, a passenger swore at the guide. The guide picked up a rock and hurled it at the passenger. The rock missed, but the passenger was in a state of shock that he would even attempt such a thing. Disagreements between passengers themselves can also turn nasty. Other arguments may erupt over permits and permission with Chinese authorities, who are not noted for their politeness. In all of these situations, mediation skills are called for: stay cool, be patient, be polite yet insistent, and keep your temper to yourself.

Women travellers

Although Tibetan Buddhism promotes a code of respect, there have been cases of harassment of Western women by Tibetan men, especially on crowded buses and when hitching rides in trucks. Tibetan women dress modestly, with little flesh exposed, and that may be the key here: a Western woman wearing shorts and a revealing top may send out the wrong message, and is bound to attract the wrong kind of attention. For these reasons, travelling solo in Tibet is not advisable for a woman. However, a woman who speaks enough Tibetan – and who dresses modestly – should not have a problem. Chinese men and Chinese military appear to have little interest in sexual advances to Western women, perhaps due to the phenomenon of numerous Chinese prostitutes plying their trade at karaoke bars in the larger towns of Tibet.

Travelling with a disability

Until the 1990s, there was only one elevator in the whole of Tibet, at what was then known as the Holiday Inn in Lhasa. Tibetans used to sneak into the hotel to experience this wonder of the Western world. That will give some idea of the problems facing disabled travellers: Tibet can be a very rough ride. If hotels lack elevators, think about monasteries – none of them have anything remotely resembling an elevator. And monasteries and fortresses are often built on hilltops, with steep access.

Still, if a blind climber can overcome the obstacles and make it to the top of Everest, then nothing is impossible. Erik Weihenmayer made it to the summit in 2001 from the Nepalese side. In 2004, he came to Tibet to visit his friends Sabriye Tenberken and Paul Kronenberg, the co-founders of Braille Without Borders, a project in Lhasa to help blind Tibetans. Erik inspired blind teenagers at this school to climb on Rongbuk Glacier at the north side of Everest. A documentary called Blindsight was released in 2006, describing these encounters. The best advice for disabled travellers is to ensure that you are going with a travel agent knowledgeable about potential problems and hazards, and who can provide the logistical support and help needed. Navyo Nepal is a Kathmandu-based operator with experience in organising tours for disabled travellers in Nepal and Tibet.

Travelling with children

Tibet presents challenges for travel with young children, as the dryness and altitude can make them irritable. Then again, as so few foreigners come to Tibet with children, this is of great fascination to local Tibetans, who fawn over the kids. Be aware that medical facilities are sub-standard in Tibet, so you will need to second-guess on the medical front and arrive well prepared for any contingencies. It’s hard to say what would make Tibet entertaining for kids. Monasteries, probably not. But kids love yaks – they are new creatures to marvel at. Going to see the yak dance at a place like Shangri-La Bar in Lhasa will be a definite hit.

To set up connections with Tibetan culture, buy some picture books for kids. Available in Delhi or Kathmandu is a ten-page book titled I am a Yak, which introduces nomad culture. Others in this series published in India include How the Yak got his Long Hair, A Snowlion’s Lesson and The Three Silver Coins. In the West, Tibetan folklore and Buddhist animal tales are available in books for young readers. And the classic story about the yeti is found in Herge’s comic book, Tintin in Tibet.

LGBT travellers

There are no particular taboos or caveats for gay and lesbian travellers visiting Tibetan regions. Buddhism is an easy-going religion, and highly tolerant. In a country (China) where men (or women) often stroll hand in hand as a show of friendship, gay travellers should not raise any eyebrows. Some tour agents market gay and lesbian tours to Tibet, or have done so in the past. These include Out Adventures and Hanns Ebensten Travel.